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He would show up on his own at Dix or Holly Hill, a private hospital in Raleigh where he had been treated previously, asking to get in. Holly Hill usually sent him to Dix, where he would stay for a few days before being sent away.

During a one-day stay in September 2006, he told Dix staff that he wanted to go to a drug treatment program in Charlotte. The program took only Mecklenburg residents, but a hospital social worker gave him the program's telephone number and a bus schedule for the Queen City.

He didn't go. Back at Dix a month later, Yarborough fought his planned release.

"I knew it that it was only a matter of time that my depression and addiction combined together with the number of drugs that I was doing, that I was going to end up killing someone or being killed," Yarborough said, "and I was afraid."

Hospital social workers did make appointments for him at one treatment center and set up a meeting with county drug counselors, but Yarborough often failed to show up. He also met three times with a psychiatrist who worked for Wake County.

He was on his own to get to all his appointments.

A common theme

This is a fairly common theme. People with mental illness aren't easy to work with, and they need help to schedule and attend appointments and encouragement to take their medication. The new network of caregivers finds it difficult to spend enough time with many of them.

Laura White, team leader for the state psychiatric hospitals, said it's difficult for hospitals to develop detailed community-care plans for people admitted for short stays, many of them substance abusers.

"Our hospitals aren't the best place for some of these folks," she said.

Yarborough said he didn't get better until he accepted that he has bipolar disorder -- a diagnosis from years ago -- and understood how he used crack to ward off his depression.

He has been sober for a year and is living at the Raleigh Rescue Mission, a nonprofit that ministers to the homeless and addicted. He had been there before and went back on his own.

Through the mission, he has found help from a mentor and a doctor, and he's working at a construction job.

Good intentions

The 2001 law that changed the mental-health system was designed to allow North Carolina to take better care of people such as Yarborough. It took local governments out of the treatment business and made them responsible for monitoring private companies that offer counseling, education and other services.

The aim was to increase variety, let patients choose their counselors and limit office-bound counseling sessions in favor of serving clients in their homes, in homeless shelters, schools and other everyday settings.

As they handed work to private companies, most county and regional mental-health offices stopped offering psychiatric appointments and day treatment. Hundreds of companies rushed in to offer community support, for which they could charge up to $61 an hour and have employees with high school diplomas or GEDs do most of the work.

Many counties never found enough private companies to offer a variety of serious treatments, leaving some regions with little more than the most basic services.

Patients lose services

"We became a private-driven system all of a sudden," said Debra G. Dihoff, executive director of the National Alliance on Mental Illness in North Carolina. "We're reaping the consequences of it now."

The 2001 law focused on how the local mental-health offices were to do their jobs and who had authority over them. The law says little or nothing about what kinds of needs the area programs should meet, how much money they would need and where they would get it.

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